Medicine for Mountaineering. James A. Wilkerson, M.D., Editor. The Mountaineers, Seattle, 1985. 438 pages, black and white drawings, diagrams and tables. Appendices, glossary, index. $8.95.

This sixteen-ounce medical and surgical textbook is worth its weight in hard rock. It presents sage advice on Second Aid, i.e., what to do when the doctor is more than one day away. Additionally, it is an extensive compendium of facts, figures and physiology related to expedition planning, medications, high altitude, hypothermia and medical kits, among many other topics. An impressive list of medical mountaineers, led by Dr. James A. Wilkerson, has put together a readable and informative text on injuries, nontraumatic illnesses and environmental aspects of medical problems that are related to both mountaineering and the outdoors in general.

The best way to use this book is for the designated medical officer of the group to read and underline it once, before the expedition. To read it first at the time of serious illness or trauma is of considerably lesser value.

Medical areas covered include everything from how to do a physical examination to fluid replacement therapy, dislocated shoulder, high-altitude cerebral edema, punctured lung, appendicitis, tracheostomy, skull fractures—everything! It makes fascinating reading, but be extremely careful not to exceed your own degree of competence.

A broad variety of medical topics is covered which will reward planners in the months before (medical supplies), during (a panoply of treatments) and after (evacuation) the expedition. As an example, the chapter on prevention measures is particularly useful, covering immunizations, hepatitis, sanitation and water disinfection.

Appendices include medications and their dosages and complications, that are arranged according to system areas, as cardiovascular and gastrointestinal systems. Among other appendices are antimicrobial therapy, administration routes of medications and cathaterizations. The proper disclaimers have been included and should be taken seriously regarding the hazards associated with many of the therapies described. This is a medical-surgical text, not a first-aid book.

Thus, a note of caution is advisable. The book is based upon the premise of diagnosing and treating all medical and surgical conditions in a remote area when no doctor is available. With a serious medical problem, it has the objective that, although some treatments may actually be hazardous, giving no treatment may be disastrous.

However, the premise of physician care is primum non nocera, firstly do no harm. Therefore, carefully evaluate each serious situation, and the recommended treatment from the book that you attempt, in terms of your own expertise, responsibility and ethics.

In summary, the integrity and lucid styles of each of the contributors makes this a highly recommended text for background study and medical care.

Michael Wiedman, M.D.